title: Colorectal cancer screening with blood-based biomarkers: cost-effectiveness of methylated septin 9 DNA versus current strategies.
abstract: BACKGROUND
  Screening reduces colorectal cancer mortality, but many persons remain unscreened. Screening with a blood test could improve screening rates. We estimated the comparative effectiveness and cost-effectiveness of colorectal cancer screening with emerging biomarkers, illustrated by a methylated Septin 9 DNA plasma assay ((m)SEPT9), versus established strategies.
  
  
  METHODS
  We conducted a cost-utility analysis using a validated decision analytic model comparing (m)SEPT9, fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), sigmoidoscopy, and colonoscopy, projecting lifetime benefits and costs.
  
  
  RESULTS
  In the base case, (m)SEPT9 decreased colorectal cancer incidence by 35% to 41% and colorectal cancer mortality by 53% to 61% at costs of $8,400 to $11,500/quality-adjusted life year gained versus no screening. All established screening strategies were more effective than (m)SEPT9. FIT was cost saving, dominated (m)SEPT9, and was preferred among all the alternatives. Screening uptake and longitudinal adherence rates over time strongly influenced the comparisons between strategies. At the population level, (m)SEPT9 yielded incremental benefit at acceptable costs when it increased the fraction of the population screened more than it was substituted for other strategies.
  
  
  CONCLUSIONS
  (m)SEPT9 seems to be effective and cost-effective compared with no screening. To be cost-effective compared with established strategies, (m)SEPT9 or blood-based biomarkers with similar test performance characteristics would need to achieve substantially higher uptake and adherence rates than the alternatives. It remains to be proven whether colorectal cancer screening with a blood test can improve screening uptake or long-term adherence compared with established strategies.
  
  
  CONCLUSIONS
  Our study offers insights into the potential role of colorectal cancer screening with blood-based biomarkers.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305-5187, USA. uri.ladabaum@stanford.edu
authors.forename: Uri
authors.initials: U
authors.lastname: Ladabaum
authors.forename: John
authors.initials: J
authors.lastname: Allen
authors.forename: Michael
authors.initials: M
authors.lastname: Wandell
authors.forename: Scott
authors.initials: S
authors.lastname: Ramsey
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D003113:Colonoscopy / Q000191:economics / Q000379:methods; D015179:Colorectal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000191:economics* / Q000235:genetics; D003362:Cost-Benefit Analysis; D019175:DNA Methylation; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D006801:Humans; D016133:Polymerase Chain Reaction / Q000191:economics / Q000379:methods; D011446:Prospective Studies; D058112:Septins / Q000097:blood / Q000235:genetics*
chemical_list: D014408:Biomarkers, Tumor; C474315:SEPTIN9 protein, human; D058112:Septins